WikiJournal of Medicine is an open-access, free-to-publish, Wikipedia-integrated academic journal for Medical and Biomedical topics.
Wikiversity Journal of Medicine,
Wikipedia medical journal,
Free to publish,
Public peer review
The Kivu Ebola epidemic began on 1 August 2018, when four cases of Ebola virus disease (EVD) were confirmed in the eastern region of Kivu in the Democratic Republic of the Congo (DRC). The disease affected the DRC, Uganda, and is suspected to have also affected Tanzania, though the Ministry of Health there never shared information with the WHO. The outbreak was declared ended on 25 June 2020, with a total of 3,470 cases and 2,280 deaths. [...]
Other locations in the DRC affected included the Ituri Province, where the first case was confirmed on 13 August 2018. In November 2018, it became the biggest Ebola outbreak in the DRC's history, and by November, it had become the second-largest Ebola outbreak in recorded history, behind only the 2013–2016 Western Africa epidemic. On 3 May 2019, 9 months into the outbreak, the DRC death toll surpassed 1,000. In June 2019, the virus reached Uganda, having infected a 5-year-old Congolese boy who entered with his family, but this was contained. Since January 2015, the affected province and general area have been experiencing a military conflict, which hindered treatment and prevention efforts. The World Health Organization (WHO) has described the combination of military conflict and civilian distress as a potential "perfect storm" that could lead to a rapid worsening of the situation. In May 2019, the WHO reported that, since January of that year, there had been 42 attacks on health facilities and 85 health workers had been wounded or killed. In some areas, aid organizations have had to stop their work due to violence. Health workers also had to deal with misinformation spread by opposing politicians. Due to the deteriorating security situation in North Kivu and surrounding areas, the WHO raised the risk assessment at the national and regional level from "high" to "very high" in September 2018. In October, the United Nations Security Council stressed that all armed hostility in the DRC should come to a stop to address the ongoing outbreak better. A confirmed case in Goma triggered the decision by the WHO to convene an emergency committee for the fourth time, and on 17 July 2019, the WHO announced a Public Health Emergency of International Concern (PHEIC), the highest level of alarm the WHO can sound. On 15 September 2019, some slowdown of cases was noted in the DRC. However, contact tracing continued to be less than 100%; at the time, it was at 89%. In mid-October the transmission of the virus had significantly reduced; by then it was confined to the Mandima region near where the outbreak began, and was only affecting 27 health zones in the DRC (down from a peak of 207). New cases decreased to zero by 17 February 2020, but after 52 days without a case, surveillance and response teams confirmed three new cases in mid-April. As a new and separate outbreak, was reported on 1 June 2020 in Équateur Province in north-western DRC, described as the eleventh Ebola outbreak since records began; after almost two years the tenth outbreak was declared ended on 25 June 2020, with a total of 3,470 cases and 2,280 deaths.
Authors: Joana Azeredo, Jean-Paul Pirnay, Diana Priscila Pires, Mzia Kutateladze, Krystyna Dabrowska, Rob Lavigne, Bob G Blasdel
Phage therapy refers to the use of bacteriophages (phages - bacterial viruses) as therapeutic agents against infectious bacterial diseases. This therapeutic approach emerged in the beginning of the 20th century but was progressively replaced by the use of antibiotics in most parts of the world after the second world war. More recently however, the alarming rise of multidrug-resistant bacteria and the consequent need for antibiotic alternatives has renewed interest in phages as antimicrobial agents. Several scientific, technological and regulatory advances have supported the credibility of a second revolution in phage therapy. Nevertheless, phage therapy still faces many challenges that include: i) the need to increase phage collections from reference phage banks; ii) the development of efficient phage screening methods for the fast identification of the therapeutic phage(s); iii) the establishment of efficient phage therapy strategies to tackle infectious biofilms; iv) the validation of feasible phage production protocols that assure quality and safety of phage preparations; and (v) the guarantee of stability of phage preparations during manufacturing, storage and transport. Moreover, current maladapted regulatory structures represent a significant hurdle for potential commercialization of phage therapeutics. This article describes the past and current status of phage therapy and presents the most recent advances in this domain.
The history of penicillin was shaped by the contributions of numerous scientists. The ultimate result was the discovery of the mould Penicillium's antibacterial activity and the subsequent development of penicillins, the most widely used antibiotics. Following an accidental discovery of the mould, later identified as Penicillium rubens, as the source of the antibacterial principle (1928) and the production of a pure compound (1942), penicillin became the first naturally derived antibiotic. There is anecdotal evidence of ancient societies using moulds to treat infections and of awareness that various moulds inhibited bacterial growth. However, it is not clear if Penicillium species were the species traditionally used or if the antimicrobial substances produced were penicillin. In 1928, Alexander Fleming was the first to discover the antibacterial substance secreted by the Penicillium mould and concentrate the active substance involved, giving it the name penicillin. His success in treating Harry Lambert's streptococcal meningitis, an infection until then fatal, proved to be a critical moment in the medical use of penicillin. Many later scientists were involved in the stabilisation and mass production of penicillin and in the search for more productive strains of Penicillium. Among the most important were Ernst Chain and Howard Florey, who shared with Fleming the 1945 Nobel Prize in Physiology or Medicine.
Authors: Sofia M. Ramos, Reinhardt G. Dreyer, Thandi E. Buthelezi
Bilateral persistent sciatic artery (PSA) is a rare vascular anomaly. We report an exceptionally rare case of complete bilateral PSAs, diagnosed on computed tomography angiography (CTA) in a patient who sustained a gunshot wound to the lower limb. Incidental PSAs are unlikely to have clinical significance, however, the unusual anatomy and higher incidence of complications requires accurate reporting of such variants. In this case, the anomaly paradoxically proved beneficial given the proximity of the gunshot wound to the femoral vessels. The embryology, clinical and imaging findings, potential complications, and treatment options regarding PSA are discussed.
Background: Wikipedia is frequently used as a source of health information. However, the quality of its content varies widely across articles. The DISCERN tool is a brief questionnaire developed in 1996 by the Division of Public Health and Primary Health Care of the Institute of Health Sciences of the University of Oxford. They claim it provides users with a valid and reliable way of assessing the quality of written information. However, the DISCERN instrument’s reliability in measuring the quality of online health information, particularly whether or not its scores are affected by reader biases about specific publication sources, has not yet been explored. [...]
Methods: This study is a double-blind randomized assessment of a Wikipedia article versus a BMJ literature review using a modified version of the DISCERN tool. Participants will include physicians and medical residents from four university campuses in Ontario and British Columbia and will be randomized into one of four study arms. Inferential statistics tests (paired t-test, multi-level ordinal regression, and one-way ANOVA) will be conducted with the data collected from the study. Outcomes: The primary outcome of this study will be to determine whether a statistically significant difference in DISCERN scores exists, which could suggest whether or not how health information is packaged influences how it is assessed for quality.
Authors: Ankita Gupta, Kate Meriwether, Sara Petruska, Sydni Fazenbaker-Crowell, Collin M McKenzie, Adam L Goble, J Ryan Stewart
Objective: We aim to evaluate hysterectomy-recovery related videos on YouTube. [...]
Methods: This cross-sectional study analyzed videos available through the YouTube interface. We calculated the views-per-day and interactions (comments, “thumbs up or down”) per 1,000 views for relevant videos. The publishers were categorized into patients, physicians, hospitals, media, industry, nonprofit, government and “other”. Video characteristics were compared between these categories using non-parametric tests. Results: We analyzed 2,092 YouTube videos related to hysterectomy recovery; 959 relevant videos published from August 30, 2006 to June 16, 2017 were included. The largest number of relevant videos were published by patients (48.6%), followed by physicians (15.8%), hospitals (12.7%), media (7.8%), and industry (7.6%). Views per day were similar between videos published by patients and physicians (median 2.1, vs median 2.6, p = 0.31). Videos published by patients had more interaction in the form of “thumbs up” votes (median 8.6/1,000 views, p<0.01) and comments (median 2.7/1,000 views, p<0.01) as compared to other categories. Conclusion: Almost half of the hysterectomy videos on YouTube are posted by patients and have more viewer interaction than other categories. Physicians should consider partnering with patient advocates to improve viewer interaction.
Systematic reviews are a type of review that uses repeatable analytical methods to collect secondary data and analyse it. Systematic reviews are a type of evidence synthesis which formulate research questions that are broad or narrow in scope, and identify and synthesize data that directly relate to the systematic review question. While some people might associate ‘systematic review’ with 'meta-analysis', there are multiple kinds of review which can be defined as ‘systematic’ which do not involve a meta-analysis. Some systematic reviews critically appraise research studies, and synthesize findings qualitatively or quantitatively. Systematic reviews are often designed to provide an exhaustive summary of current evidence relevant to a research question. For example, systematic reviews of randomized controlled trials are an important way of informing evidence-based medicine, and a review of existing studies is often quicker and cheaper than embarking on a new study. [...]
While systematic reviews are often applied in the biomedical or healthcare context, they can be used in other areas where an assessment of a precisely defined subject would be helpful. Systematic reviews may examine clinical tests, public health interventions, environmental interventions, social interventions, adverse effects, qualitative evidence syntheses, methodological reviews, policy reviews, and economic evaluations. An understanding of systematic reviews and how to implement them in practice is highly recommended for professionals involved in the delivery of health care, public health and public policy.
Authors: Kyung tak Yoo, Gowoon Woo, Tae Young Jang, Jae Seok Song
Objective: Measure time required to determine total body surface area (TBSA) burned (%TBSA) using the Lund-Browder chart and BurnCase 3D®, and calculate discrepancy between the two methods' %TBSA estimates. [...]
Methods: We asked 3 burn experts with 7 to 9 years of experience to participate in our experiment by estimating TBSA burned (%TBSA) for 26 subjects with a total of 262 photos, based on the Lund-Browder chart and the BurnCase 3D. We also measured time required for each estimation. Results: Estimations via the Lund-Browder chart and the BurnCase 3D showed statistically significant differences for Observers 1 and 2 (p < 0.05), but not for Observer 3 (p = 0.11). Inter-observer variability was insignificant among the observers (p = 0.31). When using the BurnCase 3D, burn estimation was consistent across the 3 participants (p = 0.31), yet the time spent for each method was significantly different (p < 0.05) from using the Lund-Browder chart and the time spent for estimation did not statistically vary (p = 0.20). Time spent on burn estimation varied when using either the Lund-Browder chart or the BurnCase 3D for all participants (p < 0.05). Conclusion: Using the BurnCase 3D over the Lund-Browder chart produced slightly different estimations for TBSA burned but estimation results stayed stable across inspectors. Due to the small sample size however, further investigation is necessary.
Authors: Eric Youngstrom, Stephen Hinshaw, Alberto Stefana, Jun Chen, Kurt Michael, Anna Van Meter, Victoria Maxwell, Erin Michalak, Emma Grace Choplin, Logan Smith, Caroline Vincent, Avery Loeb, Eduard Vieta
Beyond public health and economic costs, the COVID-19 pandemic adds strain, disrupts daily routines, and complicates mental health and medical service delivery for those with mental health and medical conditions. Bipolar disorder can increase vulnerability to infection; it can also enhance stress, complicate treatment, and heighten interpersonal stigma. Yet there are successes when people proactively improve social connections, prioritize self-care, and learn to effectively use mobile and telehealth.
Authors: Salma Rehman, Parveen Ali, Kurt Michael, Aasia Rajpoot
Interpreters play an important role in the health and social care system. The aim of this review is to synthesize available qualitative studies exploring experiences of interpreters when working with individuals and groups who have experienced domestic violence and abuse or other traumatic situations. A comprehensive literature search of databases helped identify 18 studies including 3 quantitative and 15 qualitative studies published between 2003-2017. The studies were conducted in various countries and data analysis resulted in the development of 5 themes which included: ‘role and impact of interpreter’; ‘psychological and emotional impact of interpreting’; ‘workplace challenges faced by interpreters’; ‘coping strategies used by interpreters’; and ‘interpreters’ support needs’. Themes are discussed in relation to the available literature and gaps in the literature are identified.
Hepatitis D is a globally occurring liver disease. It afflicts those who have been infected by both the Hepatitis B virus (HBV) and also the Hepatitis D virus (HDV), since HDV needs the hepatitis B surface antigen (HBsAg) to replicate. It is therefore most prevalent in countries where HBV infection is also common, currently the Amazon basin and low income regions of Asia and Africa. Improved measures to control HBV in industrialised countries (such as by vaccination) have also reduced the prevalence of HDV, with the main remaining at-risk populations in those countries being injection drug users and immigrants from endemic HDV areas.
Dyslexia is a neurodevelopmental disorder characterized by difficulty learning to read and spell. Underlying deficits typically include impaired phonological awareness (an awareness of the sound structure of words) and processing; difficulty with verbal working memory; and slow verbal processing speed. Observable problems include frequent spelling errors that same-age children do not exhibit; difficulty learning how to decode individual words, including "sounding out" words; and struggling to pronounce words correctly and fluently when reading aloud. Deficits in reading comprehension often occur as a secondary consequence. [...]
Dyslexia is a heterogeneous disorder, which means that not all people with dyslexia have the same signs, symptoms, underlying deficits, or functional impairment. Children and adults with dyslexia exhibit higher rates of comorbid conditions such as developmental language disorders; attention-deficit/hyperactivity disorder (ADHD); and difficulties with motor coordination, mental calculation, concentration, and personal organization, but these are not, by themselves, markers of dyslexia. Dyslexia manifests on a continuum of severity—it is a dimensional disorder. People with this disorder have a normal desire to learn. Dyslexia is believed to be caused by both genetic and environmental factors, and their interaction. Dyslexia often runs in families. Dyslexia that develops subsequent to a traumatic brain injury, stroke, or dementia is usually called acquired dyslexia. The underlying mechanisms of dyslexia are problems within the brain's language processing. Dyslexia is diagnosed through a series of tests of memory, spelling, and reading skills. Dyslexia is separate from reading difficulties caused by hearing or vision problems or by insufficient teaching or opportunity to learn. Treatment involves adjusting teaching methods to meet the person's needs. While not curing the underlying problem, it may decrease the degree or impact of symptoms. Treatments targeting vision are not effective. Dyslexia is the most common learning disability and occurs in all areas of the world. It affects 3–7% of the population, however, up to 20% of the general population may have some degree of symptoms.
Orientia tsutsugamushi is a mite-borne bacterium belonging to the family Rickettsiaceae and is responsible for the disease scrub typhus in humans. It is an obligate intracellular parasite of trombiculid mites, in which natural transmission is maintained from the female to its eggs (transovarial transmission) and from the eggs to adults (transstadial transmission). With a genome of only 2.0–2.7 Mb, it has the most repeated DNA sequences among bacteria. It is transmitted by mite larvae (chiggers) from rodents, the natural hosts of mites, to humans through accidental bites. Naosuke Hayashi first described it in 1920, giving it the name Theileria tsutsugamushi, but it was renamed to Orientia tsutsugamushi in 1995, owing to its unique properties. Unlike other Gram-negative bacteria, its cell wall lacks lipophosphoglycan and peptidoglycan. It instead has a unique 56-kDa type-specific antigen (TSA56), which gives rise to many strains (sub-types) of the bacterium such as Karp, Gilliam, Kato, Shimokoshi, Kuroki, and Kawasaki. It is most closely related to Candidatus Orientia chuto, a species described in 2010. Primarily indicated by undifferentiated febrile illnesses, the infection can be complicated and often fatal. Diagnosis is difficult and requires laborious detection methods such as the Weil–Felix test, rapid immunochromatographic test, immunofluorescence assays, ELISA, or PCR. Eschar, if present on the skin, is a good diagnostic indicator. One million infections are estimated to occur annually in the endemic region called the Tsutsugamushi Triangle, which covers the Russian Far East in the north, Japan in the east, northern Australia in the south, and Afghanistan in the west. However, infections have also spread to Africa, Europe and South America. Antibiotics such as azithromycin and doxycycline are the main prescription drugs. There is no vaccine for the infection.
Hepatitis E is inflammation of the liver caused by infection with the hepatitis E virus. It is one of five known human hepatitis viruses: A, B, C, D, and E. HEV is a positive-sense, single-stranded, nonenveloped, RNA icosahedral virus. HEV has mainly a fecal-oral transmission route. Infection with this virus was first documented in 1955 during an outbreak in New Delhi, India. A preventive vaccine (HEV 239) is approved for use in China. [...]
Although hepatitis E often causes an acute and self-limiting infection (the viral infection is temporary and the individual recovers) with low death rates in the western world, it bears a high risk of developing chronic hepatitis in people with a weakened immune system with substantially higher death rates. Organ transplant recipients who receive medications to weaken the immune system and prevent organ rejection are thought to be the main population at risk for chronic hepatitis E. Hepatitis E infection has a clinical course comparable to hepatitis A, but in pregnant women, the disease is more often severe and is associated with a clinical syndrome called fulminant liver failure. Pregnant women, especially those in the third trimester, have a higher rate of death from the disease of around 20%. In total there are 8 genotypes; genotypes 3 and 4 cause chronic hepatitis in the immunosuppressed. Hepatitis E incidence in 2017 was more than 19 million.
Lassa fever is a viral hemorrhagic fever caused by Lassa virus (Lassa mammarenavirus), a negative-sense single-stranded RNA virus of the Arenaviridae family. In most cases Lassa virus infection is asymptomatic (presenting no symptom). When symptomatic it is characterized by mild acute febrile disease to a chronic fatal disease with severe toxaemia, capillary leak, hemorrhagic situations, shock and multiple organ failure. Early diagnosis of Lassa fever is very important because of the transmissibility of infection, the need for potent isolation of infected persons and for containing potentially infectious specimens during laboratory testing. Lassa fever was first elucidated in the 1950s, but the virus was not recognized until 1969 when it infected two missionary nurses in Lassa Village, Borno State, Northeastern Nigeria. Natal multimammate rat or common African rat of Mastomys genus are the reservoir of Lassa virus. When the rodents become infected with Lassa virus, they infect humans through their urine and faeces, but remain unharmed. Because of its similarities with other febrile diseases such as malaria, typhoid, Ebola hemorrhagic fever, early detection is difficult. Thus when persons have persistent fever not responding to normal conventional therapies, they should be screened for other possible causes (especially in endemic regions). When the presence of Lassa fever is established in a community, immediate isolation of infected individuals, screening, standard infection prevention and control practices and meticulous contact tracing can halt outbreaks. Treatment involves supportive measures and early use of the antiviral drug ribavirin.
The Western African Ebola virus epidemic (2013–2016) was the most widespread outbreak of Ebola virus disease (EVD) in history—causing major loss of life and socioeconomic disruption in the region, mainly in the countries of Guinea, Liberia, and Sierra Leone. The first cases were recorded in Guinea in December 2013; later, the disease spread to neighboring Liberia and Sierra Leone, with minor outbreaks occurring elsewhere. It caused significant mortality, with the case fatality rate reported which was initially considerable, while the rate among hospitalized patients was 57–59%, the final numbers 28,616 people, including 11,310 deaths, for a case-fatality rate of 40%.* Small outbreaks occurred in Nigeria and Mali,* and isolated cases were recorded in Senegal, the United Kingdom and Italy. In addition, imported cases led to secondary infection of medical workers in the United States and Spain but did not spread further.* The number of cases peaked in October 2014 and then began to decline gradually, following the commitment of substantial international resources. As of 8 May 2016 , the World Health Organization (WHO) and respective governments reported a total of 28,616 suspected cases and 11,310 deaths (39.5%), though the WHO believes that this substantially understates the magnitude of the outbreak.* [...]
On 8 August 2014, a Public Health Emergency of International Concern was declared and on 29 March 2016, the WHO terminated the Public Health Emergency of International Concern status of the outbreak. Subsequent flare-ups occurred; the last was declared over on 9 June 2016, 42 days after the last case tested negative on 28 April 2016 in Monrovia. The outbreak left about 17,000 survivors of the disease, many of whom report post-recovery symptoms termed post-Ebola syndrome, often severe enough to require medical care for months or even years. An additional cause for concern is the apparent ability of the virus to "hide" in a recovered survivor's body for an extended period of time and then become active months or years later, either in the same individual or in a sexual partner.* In December 2016, the WHO announced that a two-year trial of the rVSV-ZEBOV vaccine appeared to offer protection from the variant of EBOV responsible for the Western Africa outbreak. The vaccine has not yet been given regulatory approval, but it is considered to be effective and is the only prophylactic which offers protection hence 300,000 doses have been stockpiled.*
Dioxins and dioxin-like compounds comprise a group of chemicals including polychlorinated dibenzo-p-dioxins (PCDD) and polychlorinated dibenzofurans (PCDF), as well as certain dioxin-like polychlorinated biphenyls (dl-PCB), and potentially others. They act via a common mechanism, stimulation of aryl hydrocarbon receptor (AH receptor, AHR), a vital transcription factor in cells. There are very high differences in potency among these compounds, i.e. in the ability to stimulate the receptor. This leads to ten thousand fold or higher differences in doses causing similar toxic effects. Most of these compounds are eliminated very slowly in the environment, animals, or humans, which makes them persistent. They are much more soluble in fat than in water, and therefore they tend to accumulate in lipid or fatty tissues, and concentrate along the food web (bioaccumulation and biomagnification). [...]
PCDD/PCDFs are formed mostly as side products in burning processes, but PCBs were oils manufactured for many purposes. Because of toxicity and persistence, dioxin-like compounds have been regulated strictly since 1980s, and their levels in the environment and animals have decreased by an order of magnitude or more. Therefore the effects on wildlife have clearly decreased, and even populations at the top of the food web such as fish-eating birds or seals have recovered after serious effects on their reproductive capacity and developmental effects in their young especially in 1970s and 1980s. This does not exclude the possibility of some remaining effects. In humans the intake is mostly from food of animal sources, but because our diet is much more diverse than that of such hallmark animals as white-tailed eagles or seals, the concentrations never increased to similar levels. However, during 1970s and 1980s effects were probably also seen in humans, including developmental effects in teeth, sexual organs, and the development of immune systems. Both scientists and administrative bodies debate at the moment about the importance of remaining risks. This is very important, because the AH receptors seem to be physiologically important regulators of growth and development of organs, immunological development, food intake and hunger, and in addition regulate enzymes protecting us from many chemicals. Thus a certain level of activation is needed, although inappropriate stimulation of the receptor is harmful. This dualism emphasizes the importance of benefit versus risk analysis. As a whole, regulating the emissions to the environment is still highly important, but one should be very cautious in limiting consumption of important and otherwise healthy food items and e.g. breast feeding. Distinct toxic effects of high doses of dioxins in humans have been clearly demonstrated by frank poisonings and the highest occupational exposures. Hallmark effects have been skin lesions called chloracne, various developmental effects of children, and a slightly increased risk of total cancer rate. The highest dioxin levels have been ten thousand fold higher than those seen in the general population today.
Objective: To assess and compare the readability of the twenty-five most accessed English medical articles on Wikipedia 0, 1, 5 and 10 years ago. Design: The twenty-five most accessed Wikipedia articles on diseases in August 2018 were identified for this study. The content of the lead paragraphs was formatted to remove any hyperlinks, decimals, colons, semicolons and periods used in abbreviations. An online tool was then used to assign a score to the readability of each text sample using the following formulae: Gunning FOG (Frequency of Gobbledygook) index, Flesch-Kincaid Grade Level (F-K), Simple Measure of Gobbledygook (SMOG) and Flesch Reading Ease (FRE). A single reading grade (RG) was calculated for each passage by averaging scores from the FOG, SMOG and F-K tests to facilitate interpretation. These steps were repeated for the lead paragraph of the same medical articles as visible 1, 5 and 10 years ago on Wikipedia. Main Outcome Measures: Readability grade (RG) and reading ease (FRE score) [...]
Results: The average (mean) RG of the twenty-five most accessed Wikipedia articles on diseases in 2018 was 12.73 (95% CI = 12.07-13.38), and the average FRE score was 39.91 (95% CI = 36.09-43.74), a score considered “difficult”. The number of articles that were easier to read (lower RG and higher FRE) in 2018 was significantly higher when compared to 2013 and 2008 (p<0.0001), but not significantly different when compared to 2017. When paired by titles and compared over time, a statistically significant difference in readability (RG and FRE) was seen in 2018 when compared to earlier years: 2017 (Friedman Chi-squared=13.70, p=0.0002), 2013 (Friedman Chi-squared=46.08, p<0.0001) and 2008 (Friedman Chi-squared=33.03, p=0.0001). None of the pages were written at the 7th or 8th grade level as recommended by the U.S. National Institutes of Health (NIH). Conclusions: The average readability of English Wikipedia’s medical pages has improved in 2018 when compared to previous years. Most of the health information, however, remains written at a level above the reading ability of average adults.
Authors: Gloria Likupe, Roger Watson, Salma Rehman
Aim: To evaluate the evidence published in systematic reviews on the effectiveness of interventions aimed at alleviating mealtime difficulties in older people with dementia. [...]
Background: Older people with dementia gradually lose their self-care abilities as the condition of dementia progresses and this includes the ability to eat independently. There is a large body of research into this phenomenon, including into the effectiveness of interventions to alleviate the problems which arise. Recently there have also been several systematic reviews with different conclusions about the effectiveness of these interventions. Design: A systematic review of systematic reviews. Methods: Databases MEDLINE, Cumulative Index to Nursing and Allied Health Literature (CINAHL), PsychINFO, Excerpta Medica Database (EMBASE), the Cochrane Library and the Joanna Briggs Library) were searched between January 2005-December 2018 using the search strategy: (feeding OR mealtimes OR eating OR intake OR food and drink OR nutrition OR difficulty) AND dementia AND intervention AND systematic review. The Critical Appraisal Skills Programme (CASP) checklist for Systematic Reviews was used to evaluate the reviews. Results: Eight eligible studies were retrieved; three scored 10 and five scored 8 according to the CASP checklist. Conclusion: The quality of the reviews included in the review were high. There is no strong evidence to support the use of any particular intervention for the alleviation of mealtime difficulties in older people with dementia. Methodological problems related to sample size and bias were apparent in the studies included in all the reviews and there was a lack of standardisation around interventions and outcomes across studies. Behavioural intervention, specifically Montessori education and spaced retrieval methods were considered promising and worthy of further research. Registration: The review is registered on PROSPERO